I am a Canadian Court-recognized Fentanyl Expert. I am Staff Sgt. Conor King with the Victoria Police Department. AMA!

Please explain why decriminalizing all illicit drugs and offering them as medication via physician isn’t a better alternative to violent gangs distributing the same (but often deadly b/c of unregulated fentanyl doses) products?

Why is criminalization and failed enforcement better than treating the addiction crisis as a health/medical issue?

Thanks.

Many societies around the world are asking exactly that. Dealing with addiction and drug use exclusively through the criminal justice system has had many failings. This fentanyl crisis has brought together the police with the medical community like never before and cutting edge efforts at providing opioids like heroin through legally sanctioned medical means has begun, for example, in Vancouver. These efforts will be watched closely to see if this should be expanded.

Our current approach is based on four pillars - of which enforcement is only one. The other pillars are: harm reduction, treatment and prevention. That's where our efforts are currently focused. As police, enforcement is exclusively our domain, but we partner in safe consumption sites, prevention education and with social supports through partnership initiatives like our Assertive Community Treatment teams.

In Canada, if government chose to approach it in a different way, police would respond accordingly.

This is a great answer - but can you expand on your partnership with safe consumption sites and other social supports? As a fellow Victorian, it feels like the bulk of the work in harm reduction and truly saving lives is being done by extremely dedicated people at the Grassroots level (SOLID) and groups whose main mission is based elsewhere (AIDS Vancouver Island). What is being done by law enforcement, or civil/provincial/federal governments to support those efforts?

Much of the support that we offer is by way of partnership. This is important both symbolically - so the public understand that we're working together - and practically, when it comes to establishing harm reduction services like safe consumption sites.

That practical work is important for people who use drugs to know that they can choose a safe consumption site without being arrested for possession at that site. Otherwise, why would they use it? This means that we need to work with the surrounding community, who are often concerned that a safe consumption site will lead to an increase in crime and disorder where they live. Our work there is in support of these efforts.

The symbolic work is also key. It's important for everyone to know that when we're not adversaries with organizations like SOLID it's because we both share a common goal - keeping people safe and alive. That's a core value that both organizations share.

The unsung heroes in much of the opioid crisis are BC Ambulance first responders. They're saving lives each and everyday too, along with the staff at safe consumption sites, and those in the community who get trained in and carry naloxone, thanks in many ways to the British Columbia Center for Disease Control who have worked tirelessly to put naloxone into the hands of everyone who needs it. Our officers also carry naloxone to respond to overdoses and exposure.

might be outside the scope of your work, but do your officers experience burnout and if so, what resources are available to help these officers?

eg., BCEHS' first responders - so many of them respond to all these overdose calls, with no apparent end or lessening in sight.

http://www.cbc.ca/news/canada/british-columbia/first-responders-overdose-trauma-stress-1.4115497

Our officers do get burned out. We have a strong employee assistance program and a critical incident stress management team to respond to officers after those really hard calls we get.

That's great to hear. I asked a similar question in another thread, not realizing the real AMA was over here.

I hope the trials not only work with the most difficult population (homeless) who often have a ton of serious social, psychological, and behavioural issues in addition to addictions, but also other addicts in other segments of society - the so-called "functional addicts". I would expect higher success rate with those who haven't already fallen to the bottom as street people.

I have a physician friend who works with addicts who believes prescription heroin for addicts would save lives by keeping people from turning to street drugs with unknown purity. Would also keep them under physician care so they can eventually get off it. Many are otherwise functional people who have fallen into addiction (it's not just a problem for the homeless, etc, as I know people can be pretty callous towards that segment). It's not like meth or something where users stay up for 7 days and get into violent psychosis. Opiate addicts just need their drug, and provided they have a reliable supply they can remain fairly functional otherwise, not turn to street crime, not die of overdoses, etc.

I think you've made some really terrific points here.

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In Canada, sentencing isn't up to the police - it is up to the Courts.

How did this Fentanyl thing start? Why have I been hearing about it so much over the past few months?

Fentanyl has been around for decades and played a smaller role as a illicit opioid in the street market. However, in 2012, factors changed, including the removal of the powerful prescription drug Oxycontin which had been highly abused as a street drug. That created a vacuum and organized crime groups capitalized on the opportunity realizing they could create counterfeit Oxycontin pills with fentanyl as well as selling fentanyl as "cheap" heroin.

You're hearing about it so much because it is killing people in all walks of life in unprecedented numbers.

Are the peoplw getting killed by it consuming it willingly?

Personally, I think law enforcement should be restricted to protecting people from harm due to the actions of others, not protecting them from harm due to their own actions.

However, It seems possible that unexpectedly high doses due to unknown potency is a big part of the problem. Fentanyl is powerful stuff.

Some people are taking it willingly, some people are taking it unknowingly, or they have resigned themselves to the fact that fentanyl is likely in their drugs, but they have no where else to turn.

True that most users will have no way of knowing what is the amount of fentanyl in the drugs that they have purchased and so accident overdoses occur routinely because of this unknown potency.

Our enforcement actions really focus on dealers - those who are harming others through their actions.

My understand is once OxyContin changed in formula it would turn gummy when crushed and couldn’t be snorted and abused as easily. Then the knock off pills came to market cut with fentanyl to make it cheaper.

That’s where we’d see the unexpected overdoses from people that weren’t full blown heroin junkies.

Personally I think we should focus on prevention and not getting people addicting to opiates in the first place. Some people get them prescribed like chiclets.

Dealers will always be there. If the USA can’t keep up to the problem with the resources they have I can’t see how we can.

I certainly agree that prevention is really important as a long-term solution. Time and time again we lumber from crisis to crisis without having a multi-decade plan that addresses the future societal needs and the root causes of trauma and addiction.

For those of us who are recreational drug users or who have friends who are recreational drug users, there's a lot of concern about fentanyl in the non opiate drug supply. Is there any plan to make test kits available, much like the naloxone kits are?

Here in Victoria, there is one pharmacy that does test street drugs for the presence of fentanyl. Contamination is so wide-spread in the drug market that there are a lot of positives. There may be a similar service in your area.

The police don't have plans at this point to make drug test kits available.

There were reports last spring that STS Pain was working with UVic to develop a device that could detect not just the presence of Fentanyl, but also the quantity. Do you know if this work was successful, and if so do they plan on releasing any public reports on what they're finding?

I know that STS Pain was able to test illicit drugs for the presence of fentanyl. I haven’t been updated as to their capability to test drugs for the quantity of fentanyl.

It’s no easy task. The police rely on Health Canada and they utilize gas spectrometry-mass spectrometry technology. It’s very expensive equipment.

Are you aware of any police organization that has its own mass spectrometry lab equipment, or is everyone using Health Canada? If so, is it due to regulations or budget constraints?

I'm not aware of any police organizations that use mass spectrometry. It is very expensive, in the area of $100,000+ and requires operation by someone with very specialized training. We leave that to the experts at Health Canada.

Thank you for keeping us safe! Can you confirm a lot of these drugs come from china and how are the police stopping this?

Thanks for the positive feedback. I'm really proud of my team and the work they do to help keep some of the most vulnerable people in our community safe.

Much of it is coming from China. The police are working with the Canada Border Services Agency (CBSA) to intercept fentanyl as it arrives. It's not been an easy task. Further we investigate the organized crime groups that operating in Canada that are initiating the importation. This is a top priority for police for drug enforcement.

Is the CBSA required additional training for their protection?

It's my understanding that they've undertaken changes to both their training and their procedures to keep their officers safe from fentanyl exposure.

I know some people claiming the Cannabis supply is tainted. Have you any evidence of this or can you address this concern...?

The latest info from Health Canada that tests our drugs seized on the street is that there is no fentanyl has been found in cannabis, but that's only what has been tested. We simply don't know what else could be out there. Where I worry is the issue of cross contamination. Fentanyl inadvertently getting into a supply of marihuana through careless handling by a drug dealer.

I am not second guessing your statement, just wondering if you could provide the specific link to the Health Canada info so I can pass it along? thanks for keeping everyone safe!

The bulletins that I get may not be publicly posted. I've asked /u/osoko to keep looking for an update.

Would this risk of exposure to fentanyl be lessened if marijuana was purchased at a dispensary? Asking for a friend...

1. Store front marihuana dispensaries are still illegal under the Controlled Drug and Substance Act. There’s no regulation of where marihuana dispensaries are sourcing their cannabis. Some dispensaries, I believe, are run by decent enterprising citizens. Other dispensaries are run by well-known organized crime groups. Could marihuana in the latter or even the former become cross contaminated with fentanyl ? Thankfully we haven’t seen it so far in BC, but I just don’t want to give people a false sense of security – I never expected to see this level of fentanyl contamination in other drugs. Typically cross contamination occurs because of careless handling by dealers who sell more than one drug.

When police get sued in Canada, is the officer involved responsible for paying it or does it come out of tax revenue?

In Canada, we have different civil law processes than in the United States. Additionally, in British Columbia, where we are, policing is governed by the Police Act. There are four oversight processes that a police officer in BC is beholden to, all of which do already have the authority to provide punitive action.

However, in short, it depends. For an incident that occurs during the execution of an officer's duties, being sued comes out of Department funds. For off-duty, non-policing matters, we're just like everybody else.

I noticed you didn't comb your hair for the Fighting Fentanyl video series; did you get in trouble from your wife as a result?

She thought I "looked handsome" but thought "I should be smiling more". It didn't seem appropriate for the subject. Because normally, I'm always smiling. Of course I am. I'm Irish. Which also explains my curly, curly hair.

First of all, thank you for your service. Fentanyl, and most opioids, are just absolutely awful.

So here's my 3 part question.

1-What, in your opinion, is the best way to combat the Fentanyl/overall opioid crisis?

2-Do you feel marijuana is an effective alternative to opioids?

3-Do you think the crisis will ever be put to an end?

1 - I think the best way is to reduce demand through treatment of addiction and long-term prevention; stopping use before it starts. Nobody wakes up in the morning and decides that they are going to start to live their life struggling with an addiction. Many people who use drugs do so in an effort to deal with trauma. If you deal with that trauma before it leads to addiction, in the long-term you deal with fentanyl and the overall opioid crisis.

2- I have read studies that point to marijuana having many medicinal applications including treatment of pain as a substitute for opioids and I know that marijuana is not linked to fatal overdoses. So, in my opinion, worth exploring more.

3 - Yes. It's going to be years, not months, before we come out of this crisis. It's going to take enormous effort and we need to not let it become the "new normal."

1. How would you respond to the cynical attitude that if someone overdoses by using illegal drugs then no extraordinary life-saving measures should be taken as it puts undue financial strain on medical and law enforcement personnel?

2. Given the increasing levels of fentanyl found in drugs, at what point would trafficking/distribution become murder?

As a twenty-year veteran of policing, cynicism is a tempting state of mind - even for me. That said, I, and police officers, I work with have a duty to preserve life as our number one, primary directive..... (to borrow a term from Star Trek). Our friends in the medical community have a similar duty. It's not our job to postulate as to the economic impact of life-saving measures. It's to render assistance without judgement.

There are cases across Canada where fentanyl traffickers are being charged with criminal negligence causing death. It's a complicated area of law. We'll be watching these vanguard cases and determine the need to replicate those measures over time.

Is fentanyl exposure a risk to officers? There are mixed reports.

The science concerning fentanyl's risk to first res ponders is rapidly evolving and the latest information is that exposure to the skin may not be as dangerous as we first believed. However, everyone agrees the inhalation risk is significant. Getting a lungful of fentanyl powder will not be a good day. We have to keep in mind that the science is limited only to fentanyl and carfentanyl which are well-studied. We're now facing a multitude of analogues and new novel drugs with no information about risks such as skin exposure, therefore the police can't ignore the need for basic precautions to prevent skin exposure and inhalation.

Here's an episode of the Fighting Fentanyl video series we did that shows exactly how our officers are protecting themselves from accidental exposure while processing exhibits: https://www.youtube.com/watch?v=JOkQyYxWktk&list=PL0XUKaSzVxGAWTsZwHY6S3yPCPozQsiTp&index=7

Is there any evidence (anecdotal or otherwise) to indicate that the current crisis is impacting the number of new recreational drug users in the area? That is, is there any evidence that the fear of fentanyl/carfentanyl encouraging some to simply not take up the habit in the first place?

We don't have numbers that could indicate that. But, I can tell you that we have seen overdoses and deaths by recreational drug users who unknowingly took fentanyl.

Hi Conor, thank you for doing this. It is too bad there was not an advance notice of this AMA as it is a very hot topic in our province at the moment.

There is a stigma in our city many of the housing projects which came out of tent city are full of substance abuse. Has there been any instances of anyone/multiple over doses in any of those apartment buildings?

Secondary question, there is a mental health crisis associated with drug abuse and sadly you and other first-responders are on the front lines dealing with the fall out of this drug use. Does VicPD offer any education to users around opiod use and it's dangers?

Yes, sadly, there have been both fatal and non-fatal overdoses at apartment buildings that have come about after Tent City. There were also, sadly, fatal and non-fatal overdoses at Tent City.

Education for users of illicit substances is largely in the realm of our harm-reduction partners and we support their efforts. That said, we do talks in schools about the dangers of opioids, particularly fentanyl so that high school students fully understand the risks of the current drug situation.

More and more we are called to non-criminal incidents, that are often associated to mental health and/or addiction concerns. Police are one of the few 24hr/7day a week resources available and, it's our primary duty to keep people safe. In BC under the Mental Health Act, it is police exclusively who can detain someone and transport them for psychological assessment, so we're a key part of the current approach to mental health crisis. That's partially why we needed additional officers for the ACT teams.

Does fentanyl powder become airborn when disturbed, or is heavier and more like grains of sand?

Many people who work in the post office are concerned about exposure. Processing centers were issued Narcan kits just in case.

In our experience Fentanyl powder can easily become airborne when mishandled. It's also the unknown, novel drugs and of course the other substances that Fentanyl is often mixed with that we know little to nothing about that presents a risk. For our officers, we take a better safe than sorry preventative approach to safety.

Do heroin addicts, the users not dealers, prefer their heroin to be laced with fentanyl?

Some people just want heroin. They don't want to run the risk of dying from an overdoes because of fentnayl in their drugs. Others, we've come to learn, DO want fentanyl in there heroin, because it provides a different level of euphoric effects.

Is "teaching kids about drugs and addiction" really the answer to fentanyl? I believe construction workers make up a significant amount of OD deaths.

They get injured and must use opioids to manage pain. Perhaps they get hooked, but the prescription is cut off.

A senior manager at Thompson Rivers OD'ed in Victoria recently. He was a former athlete. I suspect he became addicted after using a prescription opioid to manage pain.

Sergeant, isn't the real issue prescription opioids?

We need to be thinking long-term so that we don't set up the next opioid crisis with our kids as the victims. That's why I make mention of what we should do with our kids - with the answer of building our resiliency.

As far as the current victims, yes, there is a link between prescription drug use and those who turn to heroin/fentanyl when the prescription drugs are no longer available or affordable.

Part of the piece here is "why do they get hooked when others do not". Many people are prescribed prescription pain medications and do not end up living with addiction. Building resilience may help answer that question, but it's a generation away.

Can you give some prediction as to how governments and law enforcement might go about solving the overdose crisis? I'm a front line medical worker and I haven't seen much slowdown in the number of overdoses we see; at the end of every month we get our usual bump in numbers and an occasional jump when a "bad batch" hits the streets like what occurred last week.

What does our end game look like?

I too am frustrated and baffled by the ever-climbing numbers of overdoses and deaths.

This is a problem that will be solved over years, not months. Given the gravity of the situation, government needs to explore all possible remedies, for instance, legitimate substitutions for illicit opioids as seen in Vancouver. Once considered revolutionary, this approach may hold the key to saving lives.

Whatever ends up being the solution, I can tell you that this becoming "the new normal" isn't one I want to see.

I have two young children in elementary school, are there steps we should be taking as parents, schools, or communities that help reduce the risk to everyone?

At that age the goal is prevention - stopping addiction before it starts. The research shows that much of addiction is linked to early life trauma. One of the best ways to guard kids against trauma is building resiliency during childhood. Kids need at least one loving, supportive adult in their life. More is better. Sounds like that's what you're already doing.

I am a subscriber to the theory that we should talk to our kids about drugs when age appropriate because being informed and making smart choices is always better than the alternative.

I'm not an expert in preventing addiction through childhood development, but through years of policing this is what I've seen and what I'm doing with my own kids.

Are there any conclusive ties to money laundering at BC Casinos and fentanyl?

You might not be able to say, but are you and your team involved in this investigation, since you deal with trafficking?

Are the casinos on the island being investigated?

http://vancouversun.com/news/national/exclusive-how-b-c-casinos-are-used-to-launder-millions-in-drug-cash

http://vancouversun.com/news/national/highest-proportion-of-high-rollers-at-river-rock-casino-are-real-estate-professionals-internal-audit

Not that I can answer, sadly.

Isn't the rise in fentanyl timed exactly to when doctors were forced to stop the higher strength narcotic prescriptions? Now the same people with the same need are having to go to the street for it?

We seem to have thought that because a few people were having trouble with prescribed meds that by just banning for everyone the need for the drug would magically stop. Instead they are forced to obtain through illegal means, getting strengths and other contamination that they can't handle which is causing far more deaths than the problem we started with.

It seems to me the solution is to understand the use will continue and allow these people to go back for the stronger product from their doctors again. However many were in trouble with legal medications before, it was still better than what is happening now.

You're right.

Fentanyl was already present in the illicit drug market, but as a very small part of the market overall. In 2012 80mg prescription Oxycontin was discontinued as it was a heavily abused drug. The result was that enterprising organized criminals saw a market opportunity, first in selling fentanyl as counterfeit Oxycontin and then as heroin.

You've pointed out how this is a great example of unintended consequences.

Thank you for what you do.

My ex passed away from what may have been a fentanyl overdose.

I hope this nasty drug is taken off the market. Do you think that will ever happen?

Firstly, sorry for your loss.

So far we've been unsuccessful at taking other drugs like cocaine and heroin off the market and so we may well have the same outcome with fentanyl. That said, fentanyl largely comes to us from China and potentially the Chinese government can play a significant role in curbing the exportation to North America.

Fentanyl does have legitimate medical uses and it is the medical field where it should remain available.

Are Canadian law inforcement officers or politicians currently working with Chinese counterparts to reduce exportation of fentanyl? If so, I'd be interested to hear if there is communication and resource sharing exist between these two sides, considering we have not signed that extradition treaty with China. Any possibilities of joint task forces on this issue?

The RCMP and people from the Department of Global Affairs have visited with Chinese authorities and the Chinese national police. As well, US authorities including the Drug Enforcement Administration have done so. All with the goal of curtailing the production and exportation of fentanyl to North America.

Hi,

Can you explain the difference in response to this as a public health issue in comparison to the criminalization of crack cocaine in the 80s and why?

That’s great question ! Maybe the medical community and police have learned from some mistakes made in the crack epidemic ? I don’t think the medical community was nearly as engaged in the response as it is now. Of course crack cocaine wasn’t killing people at these rates, but it seems to me that there’s been an evolution in thinking about drug addiction in the last few decades. Police are better informed about the science of addiction and have partnered with the medical community to form a cohesive response. The medical community has embraced their role in addiction treatment.

Do you feel that there are direct links, or pathways of use that lead people from one "gateway" drug to another? I don't believe that Cannabis presents this issue in any way, but what ARE the starting points for children in today's schools? Are we talking about pills such as xanax and other strong opioids? I can't imagine a well adjusted kid starting out with a needle in their arm, but they obviously get from a to b somehow...

Great question.

Research points to a link between prescription drug abuse, particularly prescription painkillers like oxycodone, morphine, hydromorphone to the eventual use of heroin. One US study indicates that four out of five heroin users started using opioids in prescription drug form. Over-prescribing of prescription drugs has been well-documented in North America. Canada and the United States consume 80% of the world's prescription painkillers. Prior to the arrival of fentanyl we were already in the grips of a prescription drug crisis. With many thousands of users addicted to prescription drugs and turning to heroin when their supply of prescription drugs is curtailed, fentanyl's arrival created a perfect storm. It entered both the prescription drug market in the form of counterfeit pills and in the growing heroin market.

Kids steal drugs from their parents medicine cabinet. If they're stealing powerful prescription painkillers, that's a potential gateway to heroin use and addiction.

How to win the war on drugs? [What is your take on regulation of drugs overall?]

The real way to "win the war on drugs" is to solve the root causes of addiction. That means healing the traumas that seem to be so common among those who use drugs and who suffer from addictions. All approaches should be looked at, particularly in light of the ongoing opioid overdose crisis we're in right now, but these really are short-term solutions to a long-term problem. Talking to our kids now about drugs and addiction and helping build their resilience now will help prevent the next opioid overdose crisis 20 years from now.

We've been fighting the so-called "war on drugs" for 50 years now. It's already been a long-term endeavour, we need recognize that it will continue to be so.

Hi, thanks for doing this!

1) what percentage of the overdoses are being caused by 'hot pockets' of fentanyl in illegally manufactured pills? 2) do you think that the majority of the opioids on the black market are from legally dispensed medication that has been diverted or from illegally manufactured products?

We don't know the percentage of 'hot spots' linked to overdoses, only to say that it is a constant concern. Particularly among those people who don't use "heroin" but believe they're getting Oxycontin pills, when in fact, they are using fentanyl.

It's nearly exclusively illicit fentanyl imported from overseas.

What is the high like?

I'm only going by what people have told me. Fentanyl and other opioids mimic the euphoric effects you have have experienced if you've ever had a "runners' high" - a release of endorphin which takes away pain and provides an overall feeling of well-being. Those euphoric effects are short-lived in the life of the opioid user. Once an addiction sets in the user is often simply trying to ward off withdrawal symptoms, rather than benefit from the euphoric feelings.

Late to the party! I was wondering if you think all drugs should be legalized and moved to a health problem?

The legalization of all drugs is perhaps an oversimplification. I certainly don't think that fentanyl should be a legally available recreational drug.

With so many deaths happening, I think that we need to look at all the options we can to prevent overdose deaths. What that looks like is best decided by the teams of experts who work together on this issue, but initiatives like prescribed heroin - which is being trialed in Vancouver - may show promise.

These are really short-term band-aid style fixes. Long-term, we need to find better ways of addressing the root causes of addiction and treating the trauma that underlies so much of it.

Sgt. King,

The slowdown of Western Canada's economy might increase drug abuse as the slowdown continues. I feel that the economic ripples from the oil crash are getting stronger, indirectly, as the savings of individuals run out and spending decreases. Do you fear that the number of Fentanyl deaths will increase due to this general slowdown of the western canadian economy? What do you think our best tools are for counter-acting this trend?

That is a very good question.

The linkage between drug abuse and the health of an economy is complex. Certainly drug use is seen poor economies where the despair or unemployment is managed through drug use. This is certainly seen in the rural US where prescription drug abuse is rampant in cities and towns hardest hit by economic downturn. Could that occur in Western Canada and oil patch related communities...potentially.

Victoria was recently rated the #2 small city by Conde Naste magazine. Clearly we have a strong economy yet we are one of the hardest hit cities in Canada in the overdose crisis. These are complex issues to correlate and study.

Are you aware of the Law Enforcement Action Partnership?

What are your thoughts regarding those who believe legalization is the best option for both drug users and officer well-being?

I am aware of LEAP.

I believe that in the current climate, severe opioid crisis across North America, it's worthy exploring all options to prevent overdose deaths. Legalization, while embraced in other countries, may or may not be the right fit for North America. But certainly, we should be studying the concept closely. And, if our governments decide it's the right option then the police will respond accordingly to uphold the new set of drug laws.

What's your opinion on Kratom and its potential for helping people get off of opioids?

I know very little about the use of Kratom. I’ve heard that it purportedly has value as a opioid replacement therapy, much like methadone. But I haven’t read studies on its effectiveness and safety. I’d need to know more before I could provide a better answer. Sorry.

Thanks for doing this.

There doesn't seem to be much discussion of this crisis beyond traditional media (newspapers, the news, radio) and I wonder if that is preventing the message from getting to the right people. I think outreach like this is a step in the right direction.

Are there any definitive statistics on the demographics of victims of overdose?

Are you aware of any plans to bring wider attention to this crisis beyond just news reports? There may already be something in place, but if there is I think it is failing to reach a mass audience. It is so easy for the uninformed to ignore reports and assume it is only junkies effected by fentanyl.

The BC Coroner Service is an excellent resource for information on the demographics of those who die from drug overdoses. They tell us that males between the age of 30 and 39 are the hardest hit demographic.

There are efforts underway to reach drug users who would not normally be exposed to tradition media. For instance the Provincial Health Authorities have formed a task group for that very purpose.

Here at VicPD we try and use every social media platform available to us, Twitter, YouTube etc to reach all walks of life. That's part of why we're doing this AMA.

I was prescribed Fentanyl for a spinal paralysis condition. Basically given a lifetime prescription for patches. After 6 months, I decided the side effects (foggy, couldn't remember a thing, basically a shell of a human) I decided to go to a pain clinic to find alternatives. The pain clinic did a very quick ablation of the nerve bundle that was trapped between my femur and hip socket, then had to prescribe a blood pressure patch to ward off detox symptoms as I got off the Fentanyl. My question: Why do doctors not just start with ablation if it is safe and indicated by symptoms, and why do they not also prescribe the blood pressure patches to help addicted patients get off fentanyl safely without the adverse side effects that make them want to slap on another patch to relieve the symptoms? It seems the best way to get people to stop is to make it painless to stop.

This question is outside of my area of expertise…generally.

I can say that thanks to increased educational opportunities for doctors – a better understanding of the long term harm opioids can do…prescribing pain medication for life is becoming less common, particularly when treating non-cancer related pain. Alternate therapy ( physiotherapy & exercise ), surgery, or even meditation is becoming more common as a form of treatment for chronic pain

Great answers here, thank you! You've addressed here, a couple of times, the presence (or lack thereof) of fentanyl in marijuana. My question is, where have we seen it present as a cutting agent? Is the appearance of fentanyl limited to street opiates (outside of a medical application), or have we seen it elsewhere?

We’ve largely seen fentanyl cut into heroin. At least that’s how it first appeared. It was used to boost the potency of lower quality heroin. Then we saw it replace heroin for a time. Buyers would believe they were getting heroin, but actually they would be getting fentanyl cut with caffeine. Now we’re seeing a bit of both, but mostly heroin and fentanyl sold in combination. And we see it in other drugs like crack cocaine and methamphetamine. It seems that on occasion its deliberately mixed with those drugs and other time it’s a contamination issue.

The way it sounds in the media, is that fentanyl is HIGHLY dangerous. I'm under the impression that it's nearly always fatal.

Is this just the fear mongering I'm hearing? If it is this dangerous, are people taking it voluntarily?

It is highly dangerous. Before fentanyl arrived in BC, prior to 2012, we had about 250 fatal illicit drug overdoses per year. Now fentanyl has fully saturated the drug market. So this year we’ll have over 1500 fatal overdoses in BC. That’s what fentanyl has done.

But yes, many people do take it every day and survive. Its’s been called a game of Russian Roulette. Sometimes you survive, sometimes you don’t. Drug addiction is powerful and people are willing to take that chance to deal with their addiction.

I recently had a stent put in an artery. The anesthesiologist told me that he would be giving me Fentanyl for pain. I was awake for the procedure. It took care of the pain. How much (in weight) does it take to kill the pain as opposed to the amount it takes to kill you? Stuff made me nervous after I found out what a small amount can be lethal ?

Hey - /u/osoko here. S/Sgt King is now off at a community meeting, but, don't fret, he'll be back and will answer your question. It may not be until tomorrow morning, but we'll answer you!

Anesthesiologist who administer fentanyl for surgical procedures take great care in providing the right amount of the drug for the individual patient. Factors such as the patient’s medical history, age and weight are considered.

I’m told ( I’m not a doctor) that a dose could range from 50 to 500 micrograms depending on the nature and duration of the surgery. That’s .05 to .5 milligrams. The science tells us that the lethal dose of fentanyl is 2mg. The illicit fentanyl we have seized from our streets has ranged in strength from .1 milligram to 6mg.

Yes, 6mg. That’s 3 times stronger than the lethal dose. Helps explain the shocking number of overdoses.

With all the overdose deaths from fentanyl, do you think providing addicts with clean drugs could be a viable solution?

Hey - /u/osoko here. S/Sgt King is now off at a community meeting, but, don't fret, he'll be back and will answer your question. It may not be until tomorrow morning, but we'll answer you!

Providing opioids like morphine, hydromorphone and even medical grade heroin ( heroin is used in some countries as a medicine and so there is medical grade heroin available) is being vigorously explored in British Columbia, so that users do not have to turn to the street drugs, with unknown amounts of fentanyl or other dangerous opioids.

Look up the Cross Town Clinic in Vancouver on Hastings street. There’s lots of interesting articles about their efforts to provide 150 clients with clean heroin and hydromorphone in a supervised injectable opioid treatment model. The goal is to stabilize the addiction and then people are in a better place for further treatment. Looks promising so far.

First, thank you for doing everything you do.

What programs are offered to help with opioid addiction? I've heard of the methadone program, but it seems, at least to me, quite unknown to many people.

In BC there's now a new Ministry of Mental Health and Addictions. There's AIDS Vancouver Island but a good place to start with many people is with their family physician, who, like never before have been educated in the field of addiction treatment. For instance, the methadone program is now joined by other opioid replacement therapies that go beyond the limitations of the methadone program.

Thanks for doing this. A Milwaukee newspaper reports that fentanyl is showing up in marijuana, which leads me to wonder:

1. How likely is this to be true?
   
2. How likely is this to be a problem here where people can buy pot from dispensaries?

Health Canada has recently indicated that they have not yet found fentanyl in seized marihuana samples sent to them. However, that doesn't mean that all marihuana is safe. Cross contamination certainly remains a concern from my perspective.

Pot from dispensaries comes from unknown origins, some of which is linked to organized crime, which is engaged in selling other illicit substances so cross contamination is a real possibility.

What roles do you feel need to be filled or what resources do you think are underutilized in dealing with fentanyl abuse and dealing with rehabilitation of those who use/used it? Is there something that could be done that is currently not?

The Vancouver Police Department recently publically called for treatment on demand. Frankly I don’t know exactly what that would look like. But it seems our medical system has often fallen short or been under funded with respect to the treatment of addiction. Though it does seem that government is fully aware of this issue and change is happening, like the creation of the Ministry of Mental Health and Addictions. In policing we commonly say “we can’t arrest our way out of this problem”. New initiatives like this may hold the answer.

What is the most interesting little known fact about Fentanyl?

If you've had surgery with a general anesthetic, aka you were "knocked out" you've used fentanyl. It's a go-to analgesic, meaning, pain-relieving drug, commonly used in surgeries.

They used it on my dog when he had knee surgery a cpl years ago. The vet surgeon made a point of explaining it beforehand. Apparently some people had been freaking out at him due to all the scary fentanyl stuff in the news.

Fentanyl has many legitimate medical uses. Surgeons and anesthesiologists take great care in using it appropriately. I sympathize with them that they have to explain that what they're using it for is completely appropriate.

How's your dog doing?

2 yrs later & he's out there every day running, swimming, wrestling with the others. Crazy to think that at one point he couldn't walk and we had to have the discussion about putting him down vs. spending thousands on surgery. Best money ever spent!

Sounds like he's a good boy!

Has carfentanil begun to show up in toxicology reports from deceased users? Has it been found in any drug tests? And what is your stance on safe injection sites?

1. Yes, carfentanil has begun to show up in toxicology reports from deceased persons. It’s being found more and more commonly on the street . The Durham Regional Police made a significant seizure in Ontario last month, 43 kilograms. That’s very alarming. Veterinary literature on the use of carfentanil to sedate a full grown African elephant recommends 13 mg as an effective dose.

I know I'm super late but is all the stuff I buy from ebay or aliexpress from China being held up in customs for up to 7 months because of possible Fentanyl being smuggled in? It's the only reason I can come up with for things taking so long to be processed.

That’s a long time to wait for something to be held up in customs. You may want to get in touch with Canada Customs to see if there’s a way you can expedite the process, although it’s outside of my area of expertise.

I don't view Twitter, so some of this information may be available there, but:

What makes you an expert in this drug, and what makes you better qualified than, say, a psychiatrist, pharmacist, or other clinically trained professional? What aspect of this drug are you qualified to present yourself as an expert on, and, please, clearly, what are your acknowledged limitations?

My area of expertise is in the illicit trafficking of this drug. I'm a police officer with 20 years experience in drug enforcement. My knowledge base is focused on drug trafficking, illicit drug use - basically the use and distribution of these drugs in the criminal milieu.

I am not better qualified than a pharmacist or pharmacologist with respect to the drug impact on the human body. Similarly, they wouldn't have expertise in the illicit trafficking of the drug on the street.

I routinely am invited to teach medical professionals including the University of British Columbia (UBC) School of Pharmacy about the illicit use of street drugs like fentanyl.

I've been recognized as an expert witness in British Columbia, Provincial and Supreme Court on the following drugs:

Cocaine Heroin Fentanyl Oxycodone Methamphetamine MDMA Marihuana GHB Ketamine LSD Psilocybin

In our court-recognition process this means I've had to prove my qualifications to a judge and withstand scrutiny by defense counsel. The judge then decides if he or she will then recognize your expertise based on your education and experience.

Have you ever inhaled marijuana cigarettes?

I actually haven't. I know many police officers who tried marihuana in their youth, but where I grew up, it wasn't popular, so no.

I have close friends who's child abuses herion. Well, by child, I mean in their 20's. I've known them since they were little. I don't think addicts, especially the younger ones are aware, or they are in denial of how even more deadly herion has become. They think fentanyl is only found on the "East Coast" (USA). Her parents feel totally hopeless, she hasn't even talked to them in years now. She has a warrant out for non-appearing at a court date for posession. She had a good childhood, but she was abused by a boyfriend who started her on dangerous drugs. Anyhow, my question is, aside from Narcotics Anonymous, is there any way to help families in situations like this? In the USA a lot of Walgreens pharmacies are now offering Narcan with training if you have a prescription, or some even OTC with training. I doubt there is an easy anwser. Second, I work in the medical field, not as an MD, but it feels so frustrating that people having been "prescribed" pain medication is being used as a scapegoat. I see where there is a connection, for sure. But, in my own experience, addicts who use heroin and other dangerous drugs often will do so if they just have access to them. MDs and they rest of us are stepping up, and a lot of changes to prescription pain medication is being done. But, I hate to see my MD co-workers seemIngly having the heap of this crisis thrown on them. As mentioned above, my friends child uses heroin, they never had a pain script. Other users I've come across didn't either. I hope in time, addiction won't have so many layers of excuses and actually focus, li,e you've said, on the trauma behind abuse. Thank you for your work on spreading awareness of Fentanyl and its deadly analogs et al.

I really feel for your friends, your friends' daughter, and yourself, having to watch from the sidelines while her life falls apart. That's one of the many harms of addiction - the impact on loved ones and families.

There are ways to help, but like your question the approach is multifaceted and complex.

You mention Narcan. Certainly, overdose prevention can help in the immediate crisis. But that's not a long-term solution. Addiction treatment is a challenging path, but an important one to take.

How families be supported is best answered with how you can help support your friends. I encourage you to be there for them. Listen to them. Support them. Hug them. They're also victims of addiction.

Hello,

I am a front line worker at one of the community agencies downtown. Inhaling substances rather than injection is a preferred way of drug use for many of our most vulnerable citizens. There is no safer space available for people to inhale and the consumption space opening up in 2018 will not allow people to inhale substances either. People are overdosing from inhaling substances and have no safe space to do so. What can community agencies do to support people who inhale substances while also protecting their staff and other patrons?

I’ve wondered about this situation too. Possibly consumption site planners do not fully understand the rate at which illicit drugs are smoked versus injected. Therefore these sites are not designed to accommodate that ingestion method. Certainly it’s complicated. Managing the off gasses from smoked drugs is more difficult that dealing with drug injection, but surely not impossible with the right set up. I do think future sites will be able to accommodate smoking, if the right people are given the right information. For now, there’s no easy answer other than the fall back advice of…don’t use alone, have naloxone available etc.

Wish I could be more helpful.

How does using police resources on a COPS-style web series help save lives during the most deadly health crisis in Canadian history?

We have an obligation to keep the public informed on what we are doing. Transparency is key in policing. We made the series in-house, with internal staff, two cameras and a laptop for little cost.

In our most recent community surveys drug crime was the top concern for the citizens we serve in Victoria and Esquimalt. Enforcement is only one pillar of the four pillar approach we're taking to this crisis, but one that we don't often speak to. Our enforcement efforts aren't targeting people who use drugs - they target those who knowingly sell the most vulnerable members of our Community drugs which will kill them, for a profit. The Fighting Fentanyl series was one way of telling that story.

Regarding enforcement, there was a recent post on our local subreddit looking for someone for a property crime. However, it's fairly well known in the community that that person has a long history with both the sexual assault/abuse of minors and the sale of drugs, including fentanyl-laced drugs. He was infamously linked with the death an 18yo woman his his hotel room earlier this year due to OD. So it's extremely frustrating to those of us in the community that he was being sought for a property crime (and is now out again!) rather than these more serious crimes. Why is it so hard to get people like this locked up for drug-related offenses so that they can stop selling drugs that kill people?

Police can't comment in detail on allegations that haven't been proven in court unless it is for an investigative purpose - so I can't comment in detail about the circumstance that you've described with a particular individual.

I can say that the police are encouraged by recent court decisions with respect to fentanyl sentencing. Where fentanyl has been recognized as a grave danger to society and traffickers have been handed strong sentences. Recently we arrested a street-level dealer with 2.7 grams of fentanyl and he was sentenced to 4 years in federal prison. That's a significant sentence when compared to cocaine and heroin convictions in the range of 6 months to a year for similar amounts.

Why not just let all the useless hardcore junkies just off themselves? They do nothing but drain our hard earned tax payer funds?

That approach just seems really callous to me. I don't think that there's an answer I can provide you with that will change what seems to be your fundamental approach to humanity.

As a police officer, I swore an oath to protect life. Someone's standing in society doesn't matter, whether they're suffering disease/addiction, they're deserving of our care and assistance.

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Sorry - it took us a few minutes to get going. This is our first AMA in the IAMA sub, so it's been a learning experience for /u/osoko who is helping me along with this one.